The known scalpel, completely carried out in metal and ideally constituted by a first portion acting as an handle and by a second portion constituting the blade, are the preferred surgical instruments for the incision of superficial and deep tissues. The use of scalpel having “a fixed blade” of traditional type is limited, especially because of problems due to its sterilization, to some special operations; the method of disinfection through steam causes the inconvenience to damage the sharpening of the blade, therefore the instrument has to be bathed in suitable disinfectant solutions that protect it from oxidizing actions, or through more advanced methods such as the gamma ray sterilization. The cutting portion, that is the blade, can have different shapes, such as straight, bulged or convex, or be button-shaped, crescent-shaped or have two cutting edges; as the handle is generally constituted by a rectilinear, flat bar, the specific shape of the blade is relevant because it has to be suitable to the specific incision or scission of the tissues and to the operating technique that the surgeon intends to adopt. These necessities have brought about the use of scalpel having interchangeable blades and to combine the suitable blades each time, so that only the handle has to be sterilized through conventional methods which are usually used also for other usual surgical instruments; moreover, blades are supplied by several manufacturing companies in pre-sterilized wrappings.
Many kind of handles are required to cover the range of the several operating techniques used; they have different length and shape, on which the differently shaped blades have to be applied.
As regards to conventional handles, constituted by a bar having a longitudinally rectilinear variable section, the grasping area is generally placed towards the blade and provided on the two faces with transversal notches or readings having the purpose of achieving a stable grip, whereas the balancing of the instrument is provided by means of a rear flat tang having a larger size than the opposite terminal part; to help the operating movements on the fleshy parts and in interosseous spaces, the head which holds the blade can be also variously angled, such as in the case of the scalpel known as “Collin” whose handle is greatly flat and has a double size compared to the usual scalpel, with the tang much rounded and allowing the grip between the thumb and the forefinger.
It is further known a double handle having interchangeable blades which can be inserted on the opposite heads, which can have two contiguous gripping areas, having different surface and which allow the use of two complementary blades necessary for specific surgical techniques.
U.S. Pat. No. 5,571,127 (DECAMPLI) discloses a scalpel handle having the physical and ergonomic features of a conventional surgical scalpel handle, but which houses a retractable blade support fit for engaging scalpel blades having standard assembling housings. The scalpel blade is extended and retracted by the surgeon's forefinger as a natural part of the supporting and guiding movement of the scalpel handle, and it is characterized by the fact to have few movable parts being therefore easily disassembled and sterilized. Moreover, methods are provided for replacing scalpel blades that are essentially the same used for conventional non-retractable scalpel handles.
U.S. Pat. No. 5,527,329 (GHARIBIAN) discloses a surgical scalpel having a retractable sleeve; an elongated handle having a delimited grip portion is releasably connected to a blade holder supporting the surgical blade. The blade holder is secured to the handle by a hook and groove assembly and through a male-to-female engagement. The sleeve slides between an extended position and a backwards position on the handle and the blade holder. The extended position of the sleeve covers the blade safeguarding the user. An arch on the sleeve contacts the hook and disengages it out of the groove to facilitate removal of the blade holder.
U.S. Pat. No. 5,312,429 (NOACK) discloses an apparatus whereby a detachable surgical blade is easily and effectively removed from blade holder handle suitable for use with detachable surgical blades. The apparatus is a two part assembly comprising a scalpel handle and a removable sliding blade-shaped element. The handle includes a blade mounting tang on the proximal end thereof and a grip on the distal end thereof. The handle has sizes such that a portion of the rear edge of the scalpel blade protrudes latitudinally beyond the perimeter of that portion of the grip adjacent to the tang. The releasable sliding blade-shaped element is slidably mountable on the handle and it is of a length such that, when assembled with the handle, the releasable sliding blade-shaped element extends forward from an intermediate section of the grip to a section of the rear grip of the tang. The release sliding blade-shaped element has a blade engaging and release ramp which inclines from the proximal end of the handle to the distal end of the handle as the blade mounting portion of the tang extends upwardly. Removal of the blade is accomplished by a one handed digitally activated sliding movement of the release sliding blade-shaped element towards the proximal end of the handle, whereas the blade engaging and release ramp engages the protruding portion of the rear edge of the blade causing the rear portion of the blade to flex upwardly and slide forward off the tang.
From a close examination of the handles used in surgical or anatomic dissection techniques, six positions can be indicated:                first position: the handle grasped as a pen with the cutting edge downwards;        second position: the handle grasped as a pen with the cutting edge upwards;        third position: the handle grasped as a knife with the cutting edge downwards;        fourth position: the handle grasped as a knife with the cutting edge upwards;        fifth position: the handle grasped as a violin bow with the cutting edge downwards;        sixth position; the handle grasped as a violin bow with the cutting edge upwards.        
Accomplishing the pen-like grip, the handle is held between the thumb, the forefinger and the middle finger having as a resting surface the first interdigital area; accomplishing the grip as a knife the handle is held between the thumb by one side and the middle finger, the ring finger and the little finger by the other side, whereas the forefinger, used with a soft pressure, presses on the dorsal face of the scalpel; accomplishing the grip as a violin bow, wherein all the five digits are used, the handle is held between the thumb by one side and the forefinger, the middle finger, the ring finger and the little finger by the other side; this grip is the most suitable for carrying out a groove turning the cutting edge of the blade upwards. All the described conventional grips involve the prevalently opened position of the hand and accordingly the handle has a mostly elongate shape. According to the new handle object of the present invention and to obtain different and more ergonomic positions of the grip, a close examination of the anatomy of the hand has been done. It has been examined the front face or palm, the rear face or dorsal, the medial edge, the lateral edge and the distal edge from which respectively the digits originate. Anatomically, the palm of the hand helps the grasping motion through the most developed protrusion corresponding to the base of the thumb constituted by the fleshy mass of three muscles, having ovoidal elongate shape with the larger portion towards the wrist; this protrusion works in combination with an other protrusion on the opposite side, less outstanding, having an elongate elliptical shape and corresponding to the little finger. The grip, according to the used handles, is directed by the different digits.
The skeleton of the hand has a slightly transversal convex shape and the spaces among the metacarpal bones are filled by the dorsal interosseous muscles and above the deep surface, the tendons of the extensor muscles of the digits run, which have a different length one from the others, the thumb 12 is shorter consisting of only two phalanxes, the middle finger 13 is the longest, the forefinger 11 and the ring finger 15 are generally of the same length and their tips arrive to the midway point of the terminal portion of the middle finger, whereas the little finger 17 ends at the high of the second interphalangic articulation of the ring finger 15.
The gripping movements of the hand on the scalpel are obtained, as well as from the combined action of the digits on it, through the balancing and guiding effect of the palm of the hand on the instrument, whereas the cutting, the incision and the scission actions of the set handle/blade are obtained through the combined action of the bending movements, extension movements, radial inclination movements, cubital inclination movements, as well as of circling movements and rotation movements of the hand according to the wrist; accomplishing the bending movement, the palmar face of the hand bends itself towards the medial surface of the forearm, whereas for the extension movement the dorsal face of the hand bends itself according the lateral surface of the forearm; accomplishing the cubital inclination movement, the hand bends itself towards the cubital side of the forearm and in the radial inclination movement the hand bends itself towards the radial side; the sequence and the combination of the above described movements cause the circling, whereas the radial rotation is obtained by the movement of the hand on its own axis. The described movements and the grasping motion used in the aforesaid three principal grips—such as a pen, as a knife and as a violin bow—are not certainly achievable through the handles of conventional scalpel, which are mainly rectilinear and elongated.
The first inconvenience is the limited grip surface and the impossibility to use correctly, in the grasping motion, the protrusion at the base of the thumb and the eminence at the base of the little finger, as well as the inconvenience of not use the palmar face in the extension and in the cubital inclination movements, which causes a weak and slightly perceivable cutting action of the scalpel.
The non-correspondence of conventional handles having an elongate bar to the anatomy of the hand causes that the cutting, incision and division motions are charged on the carpiradialis and carpiulnaris articulations which early cause stress disorders that surgeons well know.
Another inconvenience of conventional elongate handles has been observed through sophisticated studies of the working of the surgeon's hand; when he carries out through the scalpel a deep cutting motion, he is obliged to release the grip from the blade, moving his hand towards the tang of the handle. He can obtain the wanted purpose, but he has lesser control of the direction, pressure and precision of the cut.